Pharmacy Services The Forth Valley Minor Ailments Service Formulary 3 rd edition September 2009
Contents Contact numbers 2 Introduction 3 How to use this formulary PART 1 Section 5 Skin 12 Acne Eczema/Allergy Boils Section 1 Gastrointestinal 5 Indigestion Infant Colic Diarrhoea Constipation Haemorrhoids Mouth ulcers Teething Oral Thrush Section 6 Eyes 13 Tear deficiency Conjunctivitis Section 7 Ear 13 Removal of Ear Wax Section 2 Respiratory 7 Hay Fever Cough and Nasal Congestion PART 2 Summary of Preparations by 14 by BNF classification Section 3 Central Nervous System 9 Pain Section 4 Infections 10 Fungal infections Vaginal Candidiasis Athlete's Foot Viral infections Cold sores Warts and verrucae Parasitic infections Threadworms Head lice Scabies Urinary Tract Disorders
Contact numbers For Queries relating to the Forth Valley Minor Ailments Service Formulary: Prescribing Support Team NHS Forth Valley Euro House Wellgreen Place STIRLING FK8 2DJ Tel: 01786 431200 Fax: 01786 431199 For General Queries relating to the Minor Ailments Service: Forth Valley Community Pharmacist Practitioner Champions: Matthew Barclay The Toll Pharmacy, Bonnybridge Mobile: 07920-294457 Email: matthew.barclay@nhs.net Carole Smith NCC, Alloa Tel: 01259-218039 Email: 17001026l@aah-point.com Paula Harvey Tesco Pharmacy, Tel: 01786 427449 Email: paula.harvey2@nhs.net Stirling Vicky Logan Boots Pharmacy, Stirling Tel: 01786 450343 Email: vicky.logan@nhs.net Practitioner Services National epharmacy Service Helpdesk: Email: nss.psdhelp@nhs.net Tel: 0131 275 6600 For Technical or Hardware Problems These queries should be directed to your PMR / system supplier helpdesk Additional general IT Support can be obtained locally from the Forth Valley Community Pharmacy IM&T Facilitator: Suzanne MacCrimmon Mobile: : 07920-294443 Email: suzanne.maccrimmon@nhs.net 2
Introduction - how to use this formulary The Minor Ailments Service (MAS) is one of the four essential pharmaceutical care services in the new community pharmacy contract. It provides NHS management of common clinical conditions. In particular, this new service aims to: improve access to advice and medicines for common illnesses promote care through the community pharmacy setting transfer care from GPs and nurses to pharmacists where appropriate, and help address health inequalities Patients are eligible for this service if they are exempt from paying prescription charges (this excludes pre-payment certificate holders), are registered with a GP in Scotland and are not resident in a Care Home. The following groups of medicines from the British National Formulary can be provided: P and GSL medicines dressings and appliances from Part 2 of the Scottish Drug Tariff selected items from Part 3 of the Scottish Drug Tariff (listed in the relevant sections of this Formulary) No black-listed products may be supplied Additionally, several GSL or P medicines or groups of medicines are specifically excluded from MAS. At the time of writing these are: Nicotine Replacement Therapy products, Emergency Hormonal Contraception, Orlistat (Alli ), Simvastatin (Zocor Heart-Pro ) Azithromycin (Clamelle ) Contractors are advised to monitor up-to-date advice from Community Pharmacy Scotland for any changes to this list. All of the medicines listed in this third edition of the NHS Forth Valley Pharmacy Minor Ailments Service Formulary are GSL or P and the majority are included the Forth Valley Formulary. Appropriate amounts to prescribe are suggested. Two prescription only medicines (POMs) are included (Chloramphenicol Eye Drops and Fluconazole 150mg capsules). These POMs may be provided as part of the service where this is more costeffective, but you should note that these require Patient Group Directions to be available in the community pharmacy setting, signed off by each pharmacist wishing to operate under the PGD in the individual community pharmacy premises.. You will be able to use this brief formulary most effectively if you do so in conjunction with the Forth Valley Formulary, a copy of which has previously been sent to each community pharmacy in Forth Valley. The Forth Valley Formulary contains a wealth of local clinical opinion and treatment guidance and can be used to promote consistent care to patients regardless of where they present for treatment. Additional items are included in the Forth Valley Formulary which may be appropriate for the treatment of minor ailments in the pharmacy. This Formulary supports your right to use your professional judgement to determine what is clinically most appropriate for your patients and recognises your responsibility for that decision. We are confident that the medicines in this Formulary will meet the need of the majority of patients under the Minor Ailments Service. However, you can request that alternative or new medicines are considered or for minor ailments to have a formulary choice added. The 3
Formulary is managed by the New Drugs Sub-group, a sub-committee of the Area Drug and Therapeutics Committee. Supplies made as part of the Minor Ailments Service will be monitored by the NHS Forth Valley Prescribing Support Team to assess levels of compliance with this Formulary. Data from this monitoring will be provided to contractors on a regular basis. Homeopathic medicines have not been included in this formulary. Some products are prescribable on the Minor Ailments Service, however they must be licensed GSL or P medicines and be listed in the Chemist and Druggist Pricelist as such, and not blacklisted. Pharmacists are reminded that they should be competent in the use of homeopathic medicines before prescribing these. MAS Pricing Guide and Pricing Rules The recent addition of Part 7B to the Scottish Drug Tariff (SDT), resolves previous issues with pricing and payment of certain items prescribed by generic name as previously highlighted by Community Pharmacy Scotland (CPS) in their MAS Pricing Guide and Rules (Part B) produced in September 2007. Following this amendment by NSS Practitioner Services, pharmacy contractors should be paid correctly for the items when prescribed by generic name. General advice to ensure correct payment under MAS is: Prescribe by generic name Ensure you have dispensed and endorsed the OTC Packsize (as listed in this Formulary this matches the Packsize in SDT Part 7B where an entry exists) Where a product requires to be prescribed by brand name, this has been indicated in the Formulary. The only product currently affected is Clotrimazole Vaginal Tabs 500mg. Currently these should still be supplied as a non-blacklisted proprietary product, prescribed by brand name. Contractors are advised to monitor up-to-date advice from CPS on this issue. http://www.communitypharmacyscotland.org.uk/ 4
PART 1 Section 1 Gastrointestinal Indigestion (including dyspepsia and gastro-oesophageal reflux disease) Co-magaldrox SF Suspension 195/220/5 (Mucogel first choice, or Maalox ) 500ml Compound alginic acid preparations Gaviscon Advance Liquid 150ml, 300ml, 500ml Gaviscon Advance Tablets 60 H2 Receptor Antagonists Ranitidine 75mg Tablets 6, 12 Motility Stimulant Domperidone 10mg Tablets 10 Infant Colic Simeticone liquid 40 mg/ml 50 ml Diarrhoea In adults and children over 12 years. Maximum strength 2mg, maximum dose 4mg and maximum daily dose 16mg. Loperamide 2mg Capsules 8, 12 Oral rehydration sachets Prevention and treatment of electrolyte depletion is the first line treatment in acute diarrhoea. Oral Rehydration Salts (Sachets) 6/20 Constipation Bulk forming laxatives Ensure adequate fluid intake. Not to be taken immediately before going to bed. Ispaghula Husk 3.4G/3.5G 30 5
Stimulant laxatives Glycerin 1g Suppositories (Infant) 12 Glycerin 2g Suppositories (Child) 12 Glycerin 4g Suppositories (Adult) 12 Senna syrup 7.5mg/5ml 100ml Senna Tabs 7.5mg 30 Osmotic laxatives Lactulose Solution 300ml Haemorrhoids Soothing haemorrhoidal preparations Anusol Cream 23g Anusol Ointment 25g Anusol Suppositories 12 Compound haemorrhoidal preparations with corticosteroids Adults over 18 years of age Anusol Plus HC Ointment 15g Anusol Plus HC Suppositories 12 Mouth Ulcers Drugs for oral ulceration and inflammation Benzydamine 0.15% Oral Rinse Benzydamine 0.15% Spray Chlorhexidine gluconate 0.2% Mouthwash Choline Salicylate Dental Gel BP (Bonjela ) NB: Not suitable for children under 16 years of age Triamcinolone oral paste 300ml 30ml 300ml 15g 5g Teething Lidocaine Teething Gel (eg Calgel Teething Gel prescribed by non-blacklisted brand name) 10g Oral Thrush Oropharyngeal Anti-Infective Drugs Miconazole Oral Gel 15g 6
Section 2 Respiratory Hay Fever Antihistamines Cetirizine 10mg Tablets 30 Cetirizine oral solution 5mg/5ml (licensed from 2 years) 200ml Loratadine 10mg Tablets 7 Drowsiness may affect performance of skilled tasks (e.g. driving); sedating effects enhanced by alcohol. Chlorphenamine 4mg Tablets 30 Chlorphenamine Syrup 2mg/5ml 150ml Other anti-inflammatory preparations Sodium Cromoglicate 2% Eye Drops Antazoline 0.5%/Xylometazoline 0.05% Eye Drops (Otrivine Antistin ) (Avoid in angle-closure glaucoma) 5ml/ Steroid Nasal Spray Beclometasone Nasal Spray 100,180 doses Fluticasone Nasal Spray (2 nd line) 60 doses Cough and Nasal Congestion Aromatic Inhalations Menthol Crystals 5g Expectorants and demulcent cough preparations Simple SF Linctus Simple Paediatric SF Linctus 200ml Dispense up to 200ml There is little evidence to support the use of cough suppressants. For persistent cough lasting 4 to 6 weeks, the underlying cause should be established. 7
Systemic Nasal Decongestants Pseudoephedrine 30mg/5ml Elixir 100ml Pseudoephedrine 60mg Tablets 12 Topical Nasal decongestants Xylometazoline 0.1% Nasal Drops (Adults and children over 12 yrs) Xylometazoline 0.1% Nasal Spray (Adults and children over 12 yrs) Xylometazoline 0.05% Paediatric Nasal Drops (age 2yrs and over) Sodium Chloride Nasal Drops 0.9% 8
Section 3 Central Nervous System Pain Non-opioid analgesics Paracetamol 500mg Tablets 32 Paracetamol SF 120mg/5ml Suspension 100ml, 200ml Paracetamol SF 250mg/5ml Suspension 100ml, 200ml Non-steroidal anti-inflammatory drugs Ibuprofen 200mg Tablets 24 Ibuprofen 400mg Tablets 24 Ibuprofen SF Suspension 100mg/5ml 150ml Weak opioids: second-line after paracetamol Co-Codamol 8/500 Tablets (2nd line agent after paracetamol) 32 Topical Antirheumatics Movelat 40g, 80g, 100g 9
Section 4 Infections Fungal Infections Vaginal Candidiasis Canesten Pessary 500mg 1 (ensure P version supplied and labelled by brand name) Clotrimazole 1% Cream 20g Clotrimazole Vaginal Cream 10% 5g Fluconazole 150mg Capsules (PGD exists to allow use of POM pack) 1 Athlete's Foot Clotrimazole 1% Cream 20g Miconazole 2% Cream 30g Miconazole Spray Powder (Daktarin ) 100g Terbinafine Cream 7.5g Viral Infections Cold Sores Aciclovir 5% Cream 2g Warts and Verrucae Preparations for warts and calluses Salactol Paint Occlusal Application Salatac Gel 8g Parasitic Infections Threadworms All family members should be treated at the same time, even if they have no symptoms, to prevent reinfection. Mebendazole is the first-line treatment except for children under 2 years of age and pregnant women, when piperazine is the preferred choice. Mebendazole Tablets 100mg 1, 2 Mebendazole Tablets 100mg (Family Pack) 4, 8 Piperazine Oral Powder (Pripsen ) 2 10
Head Lice The Forth Valley guidelines on the treatment of head lice should be consulted before prescribing. Insecticide treatment should never be used as a preventive measure as the use of insecticidal products on a regular basis may result in insecticidal resistance. Insecticidal lotions should only be used when a living louse has been found on the head. A second treatment is always needed after 7 days to kill lice emerging from surviving eggs. It is not necessary to treat the whole family. If a course of treatment (two applications, one week apart) fails to cure, a different insecticide should be used for the next treatment. A minimum of 50mls is needed for a single application. (Refer to NHS Forth Valley Head Lice Policy). The current recommendation within the Head Lice policy is : Malathion preparations are 1 st choice, Phenothrin preparations 2 nd choice. Current recommendations are to use a mosaic approach. Always try Malathion first. Due to rationalisation of product ranges by the manufacturers concerned, there is currently only one Malathion product available on the market. No Phenothrin products exist. Hedrin has been added as an interim position to allow a second choice until the Forth Valley Headlice policy is updated. Following update of the Policy, pharmacists will be notified via the usual routes and the updated policy should be followed. Malathion 0.5% Liquid (Derbac M )(aqueous) 50ml/200ml Dimeticone 4% Lotion (Hedrin ) 50ml/150ml Bug Buster headlice detection and eradication kit 1 Nitty Gritty nit comb 1 Scabies A second treatment should always be administered after 7 days. All members of the household and close contacts should be treated simultaneously. Permethrin (Lyclear Dermal Cream) 30g Urinary Tract Disorders Potassium Citrate effervescent tablets (Effercitrate ) 12 Sodium Citrate Sachets (Cymalon ) (for patients on potassium sparing medication 6 eg ACE inhibitors, spironolactone) 11
Section 5 Skin Acne Topical Preparations for acne Benzoyl peroxide 2.5% aqueous gel (Panoxyl ) Benzoyl peroxide 5% aqueous gel (Panoxyl ) 40g 40g Eczema/Allergy Emollients Aqueous Cream 500g Diprobase Cream 50g/500g Doublebase Gel 100g, 500g Epaderm Emollient 125g, 500g Emollient Bath Additives Oilatum Emollient Balneum Plus (2 nd line) 250ml/500ml 500ml Barrier Preparations Sudocrem Metanium Ointment (2 nd Line) 60g/125g 30g Topical local anaesthetics and antipruritics Calamine Lotion Crotamiton (Eurax ) Cream Calamine Aqueous Cream 200ml 30g/100g 100g Topical corticosteroids Hydrocortisone 1% Cream 15g Shampoos and scalp preparations Polytar Liquid Capasal Shampoo Ketoconazole Shampoo 150ml 250ml 60ml, 100ml Preparations for Boils Magnesium Sulphate Paste 50g 12
Section 6 Eyes Tear deficiency, ocular lubricants and astringents Hypromellose 0.3% Eye Drops Liquid Paraffin Eye Ointment (Lacri-Lube ) Carbomer 980 eye drops 0.2% (Viscotears ) 3.5g/5g 10g Conjunctivitis For the topical treatment of acute bacterial conjunctivitis in adults, the elderly and children aged two years and over Antibacterials Chloramphenicol Eye Drops 0.5% (PGD exists to allow use of POM pack) Section 7 Ear Removal of Ear Wax Sodium Bicarbonate Ear Drops 5% Cerumol Ear Drops 11ml 13
PART 2 Summary of Preparations by BNF Classification 1.1 Antacids Co-magaldrox SF (Maalox, Mucogel ) 195/220 Suspension (500 ml) Compound alginic acid preparations Gaviscon Advance Liquid (150, 300, 500ml) Gaviscon Advance Tablets (60) Simeticone liquid 40 mg/ml (50 ml) 1.2 Motility Stimulants Domperidone tablets 10mg (10) 1.3 Antisecretory Drugs Ranitidine tablets 75mg (6, 12) 1.4 Antimotility drugs Loperamide capsules 2 mg (8, 12) 1.6.1 Bulk forming laxatives Ispaghula Husk 3.4g/3.5 g sachet (30) 1.6.2 Stimulant laxatives Glycerin 1g Supps (Infant) (12) Glycerin 2g Supps (Child) (12) Glycerin 4g Supps (Adult) (12) Senna tablets 7.5 mg (30) Senna syrup 7.5mg/5ml (100ml) 1.6.4 Osmotic laxatives Lactulose solution (300 ml) 1.7.1 Soothing haemorrhoidal preparations Anusol Cream (23 g) Anusol Ointment (25 g) Anusol Suppositories (12) 1.7.2 Compound haemorrhoidal preparations with corticosteroids Anusol Plus HC Ointment (15 g) Anusol Plus HC Suppositories (12) 3.4.1 Antihistamines Cetirizine tablets 10 mg (30) Cetirizine oral solution 5 mg/5 ml (200 ml) Loratadine 10mg Tablets (7) Chlorphenamine tablets 4 mg (30) Chlorphenamine oral solution 2 mg/5 ml (150 ml) 3.8 Aromatic Inhalations Menthol Crystals (5 g) 3.9 Cough Preparations Simple SF Linctus (200ml) Simple Paediatric SF Linctus (up to 200ml) 3.10 Systemic Nasal Decongestants Pseudoephedrine 30mg/5ml Elixir (100ml) Pseudoephedrine 60mg Tablets (12) 4.7 Analgesics Non-opioid analgesics Paracetamol tablets 500mg (32) Paracetamol oral suspension SF 120mg/5mL (100 ml) Paracetamol oral suspension SF 250mg/5mL (100 ml) Weak opioids Co-codamol 8/500 tablets (32) 5.2 Antifungal Drugs Fluconazole 150mg Capsules (1) - for vaginal candidiasis only) 5.5.1 Drugs for Threadworms Mebendazole tablets 100 mg (1, 2) Mebendazole tablets 100 mg (Family Pack) (4, 8) Piperazine Oral Powder (Pripsen ) (2) 7.2.2 Vaginal and vulval infections Canesten Pessary 500mg ( P version) (1) Clotrimazole cream 1% (20 g) Clotrimazole vaginal cream 10% (5 g) 7.4.3 Drugs used in urological pain Potassium Citrate effervescent tablets (Effercitrate ) (12) Sodium Citrate Sachets (Cymalon ) (6) 9.2.1.2 Oral rehydration therapy Oral Rehydration Salts (6/20 sachets) 10.1.1 Non-steroidal anti-inflammatory drugs Ibuprofen tablets 200 mg (24) Ibuprofen tablets 400 mg (24) Ibuprofen suspension 100 mg/5 ml (150 ml) 10.3.2 Rubefacients and other topical antirheumatics Movelat (40g, 80g, 100g) 14
11.3.1 Antibacterials Chloramphenicol eye drops 0.5% () 11.4.2 Other anti-inflammatory preparations Sodium cromoglicate eye drops 2% (various brands) (5ml/10 ml) Antazoline 0.5%/Xylometazoline 0.05% Eye Drops (Otrivine Antistin ) () 11.8.1 Tear deficiency, ocular lubricants and astringents Hypromellose eye drops 0.3% (10 ml) Liquid Paraffin Eye Ointment (Lacri-Lube ) (3.5g / 5g) Carbomer 980 (Viscotears ) eye drops 0.2% (10 g) 12.1.3 Removal of Ear wax Sodium bicarbonate ear drops 5% () Cerumol Ear Drops (11ml) 12.2.1 Nasal Allergy Beclometasone Nasal Spray (100, 180 doses) Fluticasone Nasal Spray (2nd line) (60 doses) 12.2.2 Topical Nasal decongestants Xylometazoline nasal drops 0.1% (10 ml) Xylometazoline nasal spray 0.1% (10 ml) Xylometazoline paediatric nasal spray 0.05% (10 ml) Sodium Chloride Nasal Drops 0.9% () 12.3.1 Drugs for oral ulceration and inflammation Benzydamine oral rinse 0.15% (300 ml) Benzydamine spray 0.15% (30 ml) Chlorehexidine mouthwash 0.2% (300 ml) Triamcinolone oral paste 0.1% (5 g) Choline Salicylate Dental Gel BP (Bonjela ) (15g) Lidocaine Teething Gel (eg Calgel Teething Gel prescribed by non-blacklisted brand name) (10g) 12.3.3 Oropharyngeal Anti-Infective Drugs Miconazole oral gel 24 mg/ml (15 g) 13.2 Emollient and barrier preparations Aqueous cream (500g) Diprobase cream (50g, 500g) Doublebase gel (100g, 500g) Epaderm emollient (125g, 500g) 13.2.2 Barrier Preparations Sudocrem (60 g, 125 g) Metanium Ointment (2 nd Line) (30g) 13.3 Topical local anaesthetics and antipruritics Calamine Lotion (200ml) Crotamiton (Eurax ) Cream (30g/100g) Crotamiton (Eurax ) Lotion (100ml) Calamine Aqueous Cream (100g) 13.4 Topical corticosteroids Hydrocortisone cream 1% (15 g) 13.6.1 Topical Preparations for acne Benzoyl peroxide aqueous gel 2.5% (endorse as Panoxyl ) (40 g) Benzoyl peroxide aqueous gel 5% (endorse as Panoxyl ) (40 g) 13.7 Preparations for warts and calluses Salactol Paint () Occlusal Application (10 ml) Salatac gel (8g) 13.9 Shampoos and scalp preparations Polytar Liquid (150ml) Capasal shampoo (250 ml) Ketoconazole shampoo 2% (60ml, 100 ml) 13.10.2 Antifungal preparations Clotrimazole cream 1% (20 g) Miconazole cream 2% (30g) Miconazole Spray Powder (Daktarin ) (100g) Terbinafine Cream (7.5 g) 13.10.3 Antiviral preparations Aciclovir cream 5% (2g) 13.10.4 Parasiticidal Preparations Malathion aqueous liquid 0.5% (50 ml, 200 ml) Dimeticone 4% Lotion (Hedrin ) Permethrin dermal cream 5% (30 g) 13.10.5 Preparations for minor cuts and abrasions/boils Magnesium Sulphate Paste (50g) Devices for Headlice Allowable under MAS: Bug Buster headlice detection and eradication kit (1) Nitty Gritty nit comb (1) 13.2.1.1 Emollient Bath Additives Oilatum Emollient (250 ml, 500 ml) Balneum Plus (500 ml) 15